Proposal for a new staging system for osteoradionecrosis of the mandible

Kh Karagozoglu,Eajm Schulten,S Kantola,D Rietveld,R De Bree,I Van Der Waal,Ha Dekker,T Forouzanfar

doi:10.4317/medoral.19623

Kh Karagozoglu, Eajm Schulten + Show 6 more

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https://doi.org/10.4317/medoral.19623

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Abstract

A new staging system for osteoradionecrosis of the mandible has been retrospectively applied to a group of 31 patients. In this system clinicoradiographic signs and symptoms are incorporated in a simplified manner. For imaging purposes the use of plain radiographs such as periapical films and panoramic radiographs is recommended, mainly because of their readily availability. The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes. Key words:Osteoradionecrosis, jaw bones, mandible, staging, classification.

Highlights

Osteoradionecrosis (ORN) of the jaws is a relatively rare but serious complication in patients who have been irradiated in the head-and-neck region
The aim of the present study is to evaluate the value of a new staging system, based on a combination of 1) clinicoradiographic findings, and 2) symptoms, such as pain and presence or absence of oral and/or cutaneous fistulas, in patients suffering from ORN of the mandible
Twelve patients were staged as stage I, showing exposure of mandibular bone without distinct changes on plain radiographs (Fig. 1), 15 patients were staged as stage II, showing distinct radiographic changes on plain radiographs but not extending into the lower border of the mandible (Fig. 2), and five patients were staged as stage III at the time of the diagnosis of ORN, showing radiographic involvement of the lower border of the mandible (Fig. 3)

Summary

Introduction

Osteoradionecrosis (ORN) of the jaws is a relatively rare but serious complication in patients who have been irradiated in the head-and-neck region. Its onset is usually after the first year of irradiation. There are several hypotheses on the etiology and pathogenesis of ORN. Since ORN rarely arises in the maxilla most studies are related to ORN of the mandible. Management is cumbersome and varies from a conservative approach with or without the use of antibiotics and/or hyperbaric oxygen (HbO) treatment to surgery. In an attempt to prevent the disease much attention is paid to elimination of potential odontogenic inflammatory foci prior to radiotherapy and, in case of surgical dental procedures after radiotherapy, to the prophylactic use of antibiotics and peri-operative HbO treatment

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